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Human Albumin Use in Adults in U.S. Academic Medical Centers

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Abstract

Objective:

To determine rates and predictors of albumin administration, and estimated costs in hospitalized adults in the United States.

Design:

Cohort study of adult patients from the University HealthSystem Consortium database from 2009 to 2013.

Setting:

One hundred twenty academic medical centers and 299 affiliated hospitals.

Patients:

A total of 12,366,264 hospitalization records.

Interventions:

Analysis of rates and predictors of albumin administration, and estimated costs.

Measurements and Main Results:

Overall the proportion of admissions during which albumin was administered increased from 6.2% in 2009 to 7.5% in 2013; absolute difference 1.3% (95% CI, 1.30–1.40%; p < 0.0001). The increase was greater in surgical patients from 11.7% in 2009 to 15.1% in 2013; absolute difference 3.4% (95% CI, 3.26–3.46%; p < 0.0001). Albumin use varied geographically being lowest with no increase in hospitals in the North Eastern United States (4.9% in 2009 and 5.3% in 2013) and was more common in bigger (> 750 beds; 5.2% in 2009 and 7.3% in 2013) compared to smaller hospitals (< 250 beds; 4.4% in 2009 to 6.2% in 2013). Factors independently associated with albumin use were appropriate indication for albumin use (odds ratio, 65.220; 95% CI, 62.459–68.103); surgical admission (odds ratio, 7.942; 95% CI, 7.889–7.995); and high severity of illness (odds ratio, 8.933; 95% CI, 8.825–9.042). Total estimated albumin cost significantly increased from $325 million in 2009 to $468 million in 2013; (absolute increase of $233 million), p value less than 0.0001.

Conclusions:

The proportion of hospitalized adults in the United States receiving albumin has increased, with marked, and currently unexplained, geographic variability and variability by hospital size.

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